What is a safe topical corticosteroid (steroid) cream to apply to the penis?

From the Guidelines

For adult males, a safe topical corticosteroid cream to apply to the penis is clobetasol propionate (CP) 0.05% ointment, applied once daily for 1-3 months, as recommended by the British Association of Dermatologists guidelines for the management of lichen sclerosus 1. When using topical corticosteroids on the penis, it is essential to follow proper application and usage guidelines to minimize potential side effects.

• Apply a thin layer of the ointment to the affected area once daily.
• Use an emollient as a soap substitute and as a barrier preparation to help soothe and protect the skin.
• Discuss the amount of topical treatment to be used, the site of application, and the safe use of an ultrapotent topical steroid with a healthcare provider 1.
• Be aware of the potential risks and side effects of topical corticosteroids, including skin thinning, and use them only as directed by a healthcare provider.
• If symptoms persist or worsen, or if new symptoms develop, stop using the cream and consult a healthcare provider for further evaluation and guidance. It is crucial to note that more potent steroid preparations should only be used under medical supervision due to potential side effects, and patients should be referred to a specialist urologist if they do not respond to topical steroids or if they have complications such as phimosis, urinary symptoms, or urethral stricture 1.

From the FDA Drug Label

Warnings For external use only Do not use in the genital area if you have a vaginal discharge. Consult a doctor. for the treatment of diaper rash. Consult a doctor.

The FDA drug label does not answer the question.

From the Research

Topical Corticosteroid Creams for Penile Conditions

• The use of topical corticosteroid creams has been studied in various penile conditions, including phimosis and balanitis xerotica obliterans (BXO) 2, 3, 4, 5.
• For phimosis, topical corticosteroids such as hydrocortisone 1% cream and triamcinolone 0.1% cream have been shown to be effective in increasing the complete resolution of phimosis after four to eight weeks of treatment 2, 3.
• A study comparing hydrocortisone 1% cream with triamcinolone 0.1% cream found no statistical difference between the two arms at each interval, suggesting that over-the-counter hydrocortisone 1% cream is not inferior to triamcinolone 0.1% cream for the treatment of grade 4-5 phimosis 2.
• Another study found that topical corticosteroids may increase the complete resolution of phimosis after four to eight weeks of treatment, and may also increase long-term complete resolution of phimosis assessed six or more months after treatment 3.

Safety and Efficacy of Topical Corticosteroids

• The safety and efficacy of topical corticosteroids for penile conditions have been evaluated in several studies, with most studies reporting few or no adverse effects 2, 3, 4, 5.
• A study on the use of topical steroid-based creams for balanitis xerotica obliterans (BXO) found that topical steroids seem to offer a reliable option only in the management of mild BXO limited to the prepuce in boys with minimal scar formation 4.
• Another study on the use of topical steroid therapy for phimosis found that local application of steroid cream to the phimotic foreskin may allow some degree of retraction and avert the need for circumcision, with no local or systemic side effects noted 5.

Specific Topical Corticosteroid Creams

• Hydrocortisone 1% cream and triamcinolone 0.1% cream are two topical corticosteroid creams that have been studied for the treatment of phimosis 2, 3.
• Triamcinolone cream has also been used for the treatment of phimosis, with a success rate of 82% reported in one study 5.
• The choice of topical corticosteroid cream may depend on the specific condition being treated, as well as the severity of the condition and the presence of any scarring or other complications 2, 3, 4, 5.